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THE MAGAZINE OF THE WORLD HEALTH ORGANIZATION

In this issue

Heartbeat - the rhythm of heahh World Heahh Day 1992

3

Hiroshi Nakajima Carclovascular clseases : the world's Pubic: Heahh Enemy No. 1

4

lvan Gyarfas Heahh through exerdse -

a law of nature 6 Jerry Morris & Michael Collins Don't

be

fooled by tobacco 8

Paul Wangai A van full of bikes

10

Sarah Saarberg The menace of high blood pressure

12

Thomas Strasser The Donalcl Duck fan1y takes

care of its heahh

14

Course to heart health

15

A WHO game for the young at heart Public

poi"Kf

for sound hearts

19

Pekka Puska Let music soothe your heart

21

Interview with Heikki Sarrnanto So that young hearts may thrive ...

23

Aloyzio Achutti Ideas for action

25

Sing along with Hearty

27

Yong Uk Sin & B. Vaithinathan .WHO in action

29

WHO on ...

31

Wortd Health • January-February 1992 IX ISSN 0043-8502

Correspondence should be oddressed to the Editor, World Health Mogozine, World Health Orgonizo~on, CH·1211 Genevo 27, Switzerland, or directly to outhors, whose oddresses ore given ot the end of each orticle.

For subscnp~ons see order form on poge 31.

HEALTH

page 12

World Health is the officio! illustrated mogozine of the World Health

Orgonizo~on. lt oppears six ~mes o year in English, French, Portuguese, Russion ond Sponish, ond four ~mes o year in Arobic ond For~. The Arabic

edi~on is ovoiloble from WHO's Regional Offce for the Eostem Mediterranean, P.O. Box 1517, Alexandria 21511, Egypt. The Forsi edi~on is obtoinoble from the Public Health Committee, Iron University Press, 85 Pork Avenue, Teheran 15875·4748, Iron. The Russion edi~on con be obtoined from Medicino Publishing House, Petroverigski per., 6/8, 101000 Moscow, Russian Federa~on. A Germon version is obtoinob~ from the German Green Cross, Schuhmorkt 4, IJ.3550 Morburg, Germony.

Cover photo: "Heart C", painting by Paul Giovanopoulos, reproduced by courtesy of Louis K. Meisef Gallery, New York

page ll

~des and photographs that ore not copyrighted may be reproduced provided credit is given to the World Health Orgonizo~on. Signed articles do not necessonly reflect WHO's views. The designo~ons employed and the

presento~on of material published in World Health do not imply the expres~on

of ony opinion whol>oever on the port of the Orgonizo~on concerning the legol stntus of ony country, terntory, city or orea or of its outhori~es. or concerning the delimitll~on of its fron~ers or boundaries.

World Health • Jonuory·Februory 1992

Editorial

World Heohh Day 1992 Heartbeat-

the rhythm of health

Dr Hiroshi Nakajima,

Director·General of the World Health Organization.

There is a bonus to preventing cardiovascular diseases: the life-styles recommended for healthy hearts go a long way to preventing other ills.

Such life-styles should start in childhood.

A

mong the diseases most feared the world over are heart attacks and stroke. And for good reason. These diseases, of the heart and arteries, account for a quarter of the total number of deaths each year, taking an estimated 12 million lives annually. Worldwide, they kill more people than any other single disease, and disable millions. Even worse, many victims are under the age of 65.

Given today's increased life span, these deaths are premature, causing anguish in families and loss of the talent that many countries need for economic development.

Cardiovascular diseases were once thought of as afflicting exclusively industrialized nations. Today, as developing countries modernize, as they are able to control communicable diseases, and as the life expectancy of their people increases, this is unfortu- nately no longer true.

Developing countries are still suffering from other forms of heart ailment which are not prevalent elsewhere, such as rheumatic heart disease, which is linked to poverty, and from a heart ailment transmitted by Chagas disease, a parasitic malady that afflicts about 17 million people in Latin America. To these countries the diseases of life-style are an added burden on scarce resources.

3

Healthy life-styles should start in childhood

Fortunately, cardiovascular diseases while still the top killer, are on the ' decline in a number of industrialized countries, notably countries in western Europe, North America, Australia and New Zealand, where it has been shown that through diet, exercise - particularly walking, an activity for all ages -and no tobacco, they can be prevented. In addition, there is a bonus to preventing cardiovascular diseases:

the life-styles recommended for healthy hearts go a long way towards preventing other ills. Such life-styles should start in childhood.

By devoting World Health Day 1992 to the theme of heart health, it is the aim of the World Health Organi- zation to increase public awareness of the worldwide dimensions of cardio- vascular diseases, and to sound an alarm against their spread.

WHO also urges governments to give to their health authorities the funds, the equipment, and the staff to turn the tide against heart diseases.

Through prevention, six million lives can be saved each year.

Our goal for the 2000s must be cardiovascular health for everyone.•

Hiroshi Nokoiimo, M.D., Ph.D.

4 World Health • January-February 1992

Cardiovascular diseases:

the world's Public Heohh Enemy No. 1

lvan Gyarfas

C

ardiovascular diseases are today the world's Public Health Enemy No. 1. Why?

Firstly, they account for 12 million deaths - more than any of the infec- tious diseases - and disable millions more every year. About half this figure (6 million) are dying from cardiovascular diseases in the devel- oping countries. A quarter of all deaths throughout the world are attributable to cardiovascular diseases, which suggests that we are close to a global coronary catastrophe. In industrialized countries, they are the first cause of mortality, accounting for 50% of all deaths; in developing countries, they rank third, accounting for about 15 to 16%.

Secondly, it has been projected that there will be more deaths from cardiovascular diseases than from a number of infectious diseases com- bined - among them diarrhoea!

diseases, schistosomiasis, tuberculo- sis, measles and whooping cough - in the Third World in just a decade. This will make coronary heart disease and stroke the leading cause of deaths in developing countries, striking mainly the managerial and professional classes whose skills are greatly needed for economic growth and develop- ment The projections show that Latin America will report two to three times more deaths from cardio-vascular diseases than from infectious diseases, and Asia one and a half times more;

only in Africa and the Middle East there will still be more deaths from the age-old killers such as infectious diseases.

• In eastern Europe, there has been an upward swing in mortality from cardiovascular diseases over the past two decades.

• In North America, western Europe, Japan, Australia and New Zealand, despite declining trends since the

1970s, the cardiovascular diseases are still the top killer.

• According to WHO estimates, one half of all deaths worldwide are preventable - six million lives can be saved annually.

Healthy living is the least expensive way of prevention

There are no vaccines against diseases ofthe heart and arteries. There is only prevention. For developing countries as well as developed countries, the most practical and least expensive way of prevention is not through medicines but through healthy living.

Over the past three decades in the USA, mortality from cardiovascular diseases declined by 40%. One third of that decline is attributable to technological advances such as clot- dissolving and anti-hypertensive drugs, intensive care units, coronary angioplasty and bypass surgery.

Two-thirds are attributable to meas- ures such as diets to reduce calories, fats and salts, improved control of

hypertension, the growing popularity of fitness exercises, and smoking cessation - all of which have nothing to do with drugs. These facts under- score the importance of non-pharma- cological prevention and the need for public health authorities to put new emphasis on preventive rather than curative medicine - beginning with the young - in order to save both lives and money.

The increase of cardiovascular diseases is linked in part to the aging of populations. According to United Nations projections, life expectancy is expected to reach at least 60 years by the year 2000 in the vast majority of developing countries. Studies have shown that when life expectancy increases, when deaths from infectious diseases decline, and when death rates drop to below about 15 per 1000 population, then diseases of the heart and arteries become major problems.

Such is the case in an increasing number of developing countries.

The rise in cardiovascular diseases is also linked to life-style. Yet, according to a report by the World

A consultation in Jamaica. In the developing countries of the Americas heart diseases are on the increase.

World Health • Jonumy·Februory 1992

Bank, "few countries encourage low fat, low cholesterol, low salt diets;

indeed few countries have a national nutritional policy of any kind." And exercise and fitness are not routinely encouraged in schools and places of work. Even worse, physicians in developing countries remain oriented towards acute care, rather than preventive care, the report says.

MONICA-

a WHO ten-year proiect

In 1985, WHO launched a ten-year project called MONICA- a name derived from combining and shorten- ing two words "monitoring" and

"cardiovascular" - to help the public health authorities determine whether prevention programmes are successful or not. One of the largest research projects ever undertaken, MONICA follows the trends in populations between the ages of 25 and 64 years in 26 countries through a network of 39 centres. Each centre keeps track of some 1200 people who are represen- tative of a total population of 15 million. The results so far show the presence of mortality differences by sex and race, and geographically between East and West, North and South, as well as within countries. For instance, in France there are differ- ences between populations studied in Lille, Strasbourg and Toulouse. Mort- ality rates in Toulouse were lowest because, according to the experts, the diet there is higher in oils, poly- unsaturated fats, vegetables and fruit, and lower in lipids of animal origin and saturated fats.

Increasing exercise and adopting a balanced diet

Results show that among the popula- tions studied, the least number of obese men and women are in Beijing, China (3% ), Gothenberg, Sweden (7% ), and Auckland, New Zealand (8% ). The fattest males were found in Malta (25% obese), followed by Bas- Rhin in eastern France and Kaunas, Lithuania (each with 22%). The plumpest females were found in Kaunas (45%), Novosibirsk in Siberia,

5

Nutrition education helps to combat heart diseases.

Russian Federation (43%), and Malta ( 41% ). However, overweight was a characteristic of almost all the populations studied, thus pointing to the need to change unhealthy life- styles by increasing exercise and adopting a balanced diet.

Among other WHO projects under way to prevent and control cardiovas- cular diseases are the following:

• CARDIAC (Cardiovascular Diseases and Alimentary Compari- sons), a study in 22 developed and developing countries. The major aim is to determine the link between diets and high blood pressure. It is directed by the WHO Collaborating Centre at Shimane University, Izumo, Japan.

• PEP (Patient Education Project), involving eight countries, whose major aim is to educate family doctors and nurses in methods of teaching patients with high blood pressure how to manage their condition. The World Hyper- tension League is a partner in the project.

• PBDA Y (Patho-Biological Determinations of Atherosclerosis in Youth), a five-year study carried out through 20 centres in 16 areas of the world, whose major aim is to determine how atherosclerosis develops, by studying the clogging

of arteries in the young.

• The Global Cardiovascular Diseases Monitoring and Preven- tion Project, a recently established network comprising sites in developing countries linked to the MONICA sites, aims to assist these nations develop skills to carry out programmes of prevention.

• Programme on Prevention of Rheumatic Fever and Rheumatic Heart Disease, a project in developing countries, aims to reduce the number of cases and deaths from these two diseases, whose victims are the young.

The International Society and Federation of Cardiology is a partner in the project.

It is clear that only a strong commit- ment by countries to provide funds, equipment and personnel for pro- grammes of prevention will avert the impending global epidemic of cardiovascular diseases. •

Or /van Gyarfas is Chief of the Cardiovascular Diseases Unit at the World Health

Organization in Geneva.

6 World Heolth • Jonuory-februory 1992

Health through exercise - a law of nature

Jerry Morris & Michael Collins

Each person is the best iudge of what kinds of exercise suit him or her. But exercise should be broadly encouraged by messages from public bodies.

E

xercise gives a sense of well- being. It helps to prevent obesity and coronary heart disease. It helps old people to retain their independence.

Any kind of sensible activity is good for y~u. Exercise that is more vigorous than you are accustomed to improves the bodily processes and strengthens the heart, lungs, muscles, bones and joints.

Exercise sustained long enough to make you breathe harder than usual is particularly effective in helping to strengthen the heart. The oxygen drawn in is used by the arms and legs as they work. This happens in aero- bics, walking, cycling, dancing, swimming, running, rowing, football, and many other forms of activity. By taking such exercise regularly and very gradually increasing its vigour you will improve your physical fitness and the health of your heart. As you become more active and healthy the exercise you take should cause you to breathe hard and sweat. This should happen at least twice a week and for at least twenty minutes each time.

Protection against heart attacks is achieved at moderate levels of fitness;

it is not necessary to reach your full potential in this respect. Remember, you can't store fitness. If you stop being active your fitness will rapidly decline.

Many people wish to exercise in groups. Your local library, town hall or leisure centre should be able to give you the addresses of athletic and other clubs where this can be done.

Encouraging people to be active ...

Each person is the best judge of what kinds of exercise suit him or her. But exercise should be broadly encour- aged by messages from public bodies.

Society should provide access to the country for city dwellers, safe walking routes and cycle lanes, swimming pools and recreational facilities.

Various state sectors should collabo- rate in such endeavours. Leaving health promotion exclusively in the hands of health ministries is doomed to failure.

The amount of exercise taken by people in the developed countries has,

on the whole, markedly declined during the twentieth century.

A cultural change is now needed, whereby a more sensible, life-

enhancing regimen is established, with physical activity restored as an integral element of everyday living.

Health workers can show the way but success requires an enormous effort by society in general. If progress in this area is not made now, the Third World will probably adopt the labour- saving technologies and the sedentary life-styles of the West and suffer increasingly from the diseases of affluence.

Doctors and nurses can be effective role models

Public education about exercise needs to be pervasive; leaflets and advertise- ments are not enough. The power of television could be more effectively harnessed. It is also necessary to

Practising Tai Chi in China- gymnastics for both the body and the soul.

World Health • Jonuory-februmy 1992

educate health workers themselves in personal and public issues. Health services should provide the encour- agement and facilities for their own staffs to engage in regular exercise.

Doctors and nurses can be effective role models for patients, but few actually are.

Exercise should be regarded not only as remedial for patients, but also as preventive, especially in groups at risk because of their physical charac- teristics or their exposure to stress:

people over 65, the obese, single parents, some ethnic minorities, and peqple on low incomes. General practitioners could run programmes in association with their local health centres (see box).

... at work, school and play

In developing countries, much manual labour is still performed. Those involved have little or no need of physical exercise in their leisure time.

As mechanization proceeds, however, increasing numbers of people are becoming relatively inactive. Many firms in developed countries, recog- nizing the value of a healthy work force, provide their employees with sports facilities. It is to be hoped that similar action will be taken in the developing countries. Another possibility is to take exercise on the

way to and from work by, for exam- ple, walking, running or cycling instead of travelling by car; thoughtful town planning can encourage such activity.

In the United Kingdom, 70% of the exercise that is vigorous enough to benefit the heart is taken through sport. Sport can produce muscle, joint and bone injuries but, played sensibly, it is undoubtedly advantageous. Sports and athletics clubs tend to create a commitment to exercise in their members which isolated individuals would fmd difficult to develop.

Exercise and sport should be encouraged in primary schools, where specially trained teachers should organize suitable games. Play activi- ties can be centred around exercise schemes for even younger children. In secondary schools a wide range of sporting skills and interests should be promoted. It would be cost-effective to make available the facilities in schools and colleges for use by the community for sporting and other purposes outside school hours.

Unfortunately, schools and sports facilities continue to be built as separate entities in many countries.

Improving access makes participation higher

Adults should have access to a wide range of sporting facilities at afford-

1

Health-promoting activities at Princes Park Health Centre, Liverpool, United Kingdom

• Women-only swimming• sessions

• Courses on heort care

• Relaxation/ exercise/ diet/ stress management for:

- young mothers - smokers - elderly people -well women

• Fun runs

• Sport and heolth excursions

• Small grants made to local groups

• Provision

of

information on fitness.

able cost. In western Europe the cost of subsidizing public facilities is being questioned on the ground that only a minority use them. Yet in Belfast, where provision is high and charges are low, participation is higher than in the rest of the United Kingdom.

Schools, voluntary centres, adult education classes, public leisure services and commercial centres should devise programmes for specific groups of people, bearing in mind the best times of day, styles and activities for each. We should not forget the people in prisons, hospitals and other institutions where exercise and sport may be therapeutic and an important part of social relationships. Again, of course, trained staff are required.

Humans evolved as highly active individuals. Today, many people are not meeting the evolutionary require- ment of regular vigorous exercise, and consequently their health is suffering.

For the good of the species and the individual it is vital that high levels of physical activity be encouraged throughout society. •

Professor )erry Morris is at the London School of Hygiene and Tropical Medicine, Keppel Street, London WC I E 7HT, England; Mr Michael Col/ins is Director of the Institute of Sport and Recreation Planning and Management ot Loughborough University, Ashby Rood, Loughborough LE I I BX, Leicestershire, England.

8 World Health • Jonuory-Februory 1992

Don't be fooled by tobacco

Paul Wangai

' ' Doctor, it happened in the middle of a dance floor!" Ken told me. "I have had no major illness in the past.

But the chest pain ... so sudden! So painful! It really scared the daylights out of me. Am I going to die? You know, I am engaged to be married on the 20th of next month. Nothing should spoil this great day!"

Ken is 32 years old and smokes two packs of cigarettes a day. He was introduced to smoking by a friend at the age of 11 and has been a regular smoker ever since. A number of times, I have urged him to give up the habit.

He tells me he will do so one day but that day has not yet come.

When he walked into my clinic he was visibly shaken and very scared.

He thinks something is very wrong.

And he is right: it is serious. Last night when he had this very sharp chest pain he stopped dancing and sat down. His fiancee was shocked, and the dance literally stopped. Ken was so embar- rassed. He had just experienced a mild heart attack. He went to a dispensary and got some medicines, then went home to rest.

A thorough examination and an electrocardiogram test showed clearly that my friend Ken has poor heart health. I explained the facts to him.

The heart is a wonderful pump of blood. It pumps and pumps and pumps - non-stop until we die. When young people say: "I love you with all my hearf', this is not really true.

You can't love with a heart. It is not a seat of emotion. It is simply a pump of blood.

In severe attacks, it is unable to pump enough blood to the rest of the body and death occurs. Or, if the person survives, he or she is often left with permanent damage to the heart muscle. This restricts activity, as even

"/wanted to have power, sa I puffed. What a mistake/"

slight physical exertion will bring about severe chest pain.

In a mild attack, like Ken's, the damage is not so severe. The blood and oxygen supply was sufficiently reduced to cause problems, but did not stop completely as in a severe attack.

Ken is lucky, he has a second chance.

Not everyone is so fortunate.

Smoking causes heart attacks

It is quite clearly established that cigarette smokers have a 70% greater chance of developing coronary heart disease than persons who don't smoke. Smoking is one of the impor- tant risk factors for such a heart attack.

It reduces the amount of available oxygen in the blood, causing the heart to work harder. Carbon monoxide in cigarette smoke damages the vessel wall from the inside, making it rough and therefore ready for fatty deposits to lodge there. The cigarette's poisons

also increase the heart beat. The degree of risk to the heart and circula- tory system is related to the number of cigarettes smoked daily and for how many years -and whether one inhales or not.

Furthermore, the smoke's poisons cause the red blood cells to stick together, forming clumps that are unable to pass through the smallest blood vessels, again reducing the blood and oxygen supply.

Smoking does not give power

Like most young people in developing countries, Ken started smoking at an early age, and it became a habit that is hard to quit. I remember when I took my first and last cigarette. All the boys in my class smoked in the toilets during break time. "When you smoke you become a real man", they told me.

"Where there is smoke, there is fire;

where there is fire, there is power."

I wanted to have power, so I puffed.

World Health • Jonuory·Februory 1992

What a lie! Tobacco actually destroys the body's engine, the heart pump.

In fact, 40% of heavy smokers now aged 35 years will die before reaching the age of 65, compared with only 15% of nonsmokers. Three or four out of every ten smokers will die prematurely as a result of their habit.

It has been estimated that each cigarette takes

91

minutes from the life of the average smoker.

In the developed countries, the numbers of male smokers are decreas- ing rapidly, while in the developing countries they are increasing. Women, on the other hand, are smoking more, everywhere. The smoking rates in the developed countries are decreasing by 1.5% a year, whereas they are increasing by 2% a year in the developing countries. Per capita cigarette consumption in Latin America increased by 24% between 1970 and 1980. In North America the increase was only 4% and in Africa about 30%.

Young people need to be protected

About 30% of young people aged 10 to 29 years smoke in developing countries. Many of these will end up as hardened tobacco addicts. This is a worrying feature, considering that the future of our developing nations lies with our young people. Youth is our most valuable asset.

In my home country, Kenya, we know that our accomplishments in national and international athletic events are performed by nonsmoking young people. Smoking just doesn't mix well with sports. Top athletes like Kipchoge Keino, Moses Rono and Paul Ereng do not use tobacco.

The false lure of the tobacco industry

The tobacco industry would like us to believe that they assist the economy of Third World countries. This is supposed to be in the form of income and revenue to the state coffers, and payments to farmers and workers in the tobacco industry. The facts hardly bear this out.

For one thing, the amount of

Young people ore willing to learn. Make sure they get the message that smoking is bad for the heart and causes cancer.

money used to compensate for the effects of tobacco use (as a result of illness and death) is some three times more than the amount of revenue and income to tobacco workers. Secondly, deforestation is a big problem. Curing the tobacco over wood fires calls for the widespread felling of trees, which is a prelude to soil erosion and desertification. Finally, much of the profits from tobacco sales is sent to wealthy developed countries and does not benefit the tobacco-growing countries.

In reality, we are being fooled by the tobacco industry. Unable to promote tobacco use in the developed world, the manufacturers have a free hand in doing so in the developing countries. Their advertising claims that smoking helps performance in sports and gives the impression that to be successful means to smoke; after all, successful "westemers" smoke, they claim. These messages are inaccurate, false and unethical.

The situation echoes the words of U.S. Senator Robert Kennedy when he opened the first world conference on smoking and health in 1967. He said: "The cigarette industry is peddling a deadly weapon; it is dealing in people's lives for financial gain."

How true those words are! Is it not time we ceased to encourage this deadly habit, for our heart's sake? If you smoke, quit. If you don't smoke, don't start! Your heart will be better off without tobacco. •

Tobacco control

Kenya has embarked on various ways to help young people get the message: If you want to have a good strong heart-don't smoke. Some of these are:

1. Banning tobacco advertising and promotion-including sports sponsorship;

2. Rotating a variety of health warnings on cigarette packs;

3. Increasing tobacco taxation;

4. Banning the sale of cigarettes to children;

5. Banning smoking in public places and transport;

6: Replacing tobacco by crops which contribute to the eco- nomic and social health of the community;

7. Including tobacco messages in health education and school educational curricula;

8. Arranging smoking cessation programmes;

9. Enacting legislation to curb smoking.

Or Paul Wongoi Jr is Director of Medicare Wellness Centre(s} Limited, P 0. Box 62610, Nairobi, Kenya.

9

I 0

A van full of bikes

Sarah Saarberg

Cycling-another good exercise for staying in good form.

B

icycles are one of the main features that strike tourists when they come to the Netherlands, along with wooden clogs, cheese and windmills. The number of cyclists in Holland is unbelievable: nine out of ten people own a bike. This, and the fact that cycling is an extremely healthy way of getting physical exercise, lay behind the idea of the Ride-a-Bike Promotion Van.

This is a big, white goods vehicle containing 72-equally white - bicycles. In the Netherlands, if a bicycle is painted white this signifies that it is for communal use. The bikes are a standard model without gears or crossbar. Unlike the usual models, the saddle and the handle bars can be readily adjusted making them suitable for both youngsters and adults.

Businesses, institutions, associa- tions, local authorities and also private individuals can put in a request to hire the bike van for a day at a small fee. The only condition is that a minimum of 50 bicycles have to be used.

Although nobody makes a point of it, events which have a health- or cycling-related theme are given a little preference.

Tremendous success

The van first went into action 12 years ago, as an initiative of the Netherlands Heart Foundation and the Royal Dutch Touring Club. The touring club has its hands full operating the Ride-a- Bike Van. "We are booked up from mid-March to mid-September" said Mr A. V. Melchior, head of Public

World Health • Janumyfebruory 1992

More than 1 00 000 people have used the white bicycle in the past 12 years in the Netherlands, cycling millions of kilometres

Relations and Information at the club headquarters in The Hague. "The success is tremendous. We have many more applications than we can deal with."

More than 100 000 people have used the white bicycles in the past 12 years, cycling millions of kilometres.

Replacement of the 72 bikes by the Netherlands Heart Foundation every three years is therefore no luxury but a must. "We do it every time with great pleasure," stressed Mr J.C. van Deth, director of the Netherlands Heart Foundation. "Like the Touring Club, we have been surprised in the past years at the success of the project. Our volunteers, the Friends of the Nether- lands Heart Foundation, make a major contribution in promoting the Ride-a- Bike Van. As soon as there is an event where the van could be used, we frequently get a signal from our volunteers."

The van is, of course, an extension of the objective of the Foundation.

"Lack of exercise can be regarded as one of the factors increasing the risk of heart and vascular diseases," says Mr van Deth. "That's why we do everything we can to encourage people to take more exercise. The exercise doesn't have to be strenuous;

a day out cycling is also extremely healthy. And the chances are that anybody getting on a bike will get to like it and will use the bike more often in the future."

World Health • Jonuory-Februory 1992 11

lt's fun, it's healthy

The head of personnel of a major Dutch company comments: "Until a few years ago our staff parties were synonymous with eating and drinking.

Great fun but not really very healthy. Then we heard about the Ride-a-Bike Promotion V an. Since then our annual staff party has become a sportive event. Everybody, from the managing director to the telephone operator, enthusiastically jumps on a bike for a

trip which is great fun and healthy at the same time."

The success of the Ride-a-Bike Van has led to it being used for a

second purpose. It can now be

deployed as a fitness test van. The sides of the van are lowered, creating a kind of work-out area with exercise machines coupled to a computer, enabling various fitness tests to be performed. These tests are carried out by specially trained staff from the Sports Activity Organization.

This dual purpose use is doubly advantageous for the Heart Founda- tion. First of all participants are confronted with a report on how fit they are, and then they are offered the opportunity of immediately doing something about it by going on

WORD GAME

Rearrange the

letters

shown in the second column to form a

word

which has the same meaning as the

clescrip-

tion in the first column. You will find the correct answers on page 31.

1. Heart attack CRAINTONIF

2. Brain attack KORTES

3. Pathways to the heart SNIVE 4. The oldest heart drug? SATIGILID 5. A main road from the heart TEARRY

6. High blood pressure PHENIOSENTRY 7. Heart disease of

unknown origin CYOROPHADAMITY 8. Know its level in your blood HOTOLLERCES

The whole family can take up cycling as a pleasant form of recreation ..

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

a cycling trip on one of the white bikes. •

Miss Sarah Saarberg is an official of the Dutch Heart Foundation, Post Office Box 300, 250 l CH The Hague, Netherlands.

Best exercise for young and old KWIGLAN

The rhythm

of

health BREATHATE

WHO has banned it! COBCOAT A muscle that never rests ATHER it's bad for you- get moving! CYNAVITITI

Dilatation

of

artery MAURENSY

Should be healthy throughout life TINNITOUR Ohen damaged by rheumatic fever SA VEL V

Not a good fat AUDRATEST

Another main road from the heart ORYOCARN

A heart chamber TRIVLENCE

Another heart chamber CRUELIA

Contributed by Mary:fane Watson, WHO

12 World Health • January-February 1992

The menace of high blood pressure

Thomas Strasser

Complications of hyper-

tension, namely stroke, heart attacks, and heart and

renal failure, are declining.

Today's message is:

know your blood pressure, and if it's high, have it treated.

I

n February 1944 three men met in Yalta to discuss the possible partition of power after the Second World War. Roosevelt had high blood pressure and a failing heart and died of a stroke a few weeks after the conference. Stalin was apparently in good health, yet eight years later he also died of a stroke. Churchill died in 1965, having reached the age of91 despite all the cigars he smoked. One can only speculate on the course that history might have taken had Roosevelt and Stalin lived longer.

The tragic effects of high blood pressure in hundreds of millions of ordinary people, on the other hand, are beyond dispute. Persons with high blood pressure run the risk of heart and kidney failure, heart attacks and, particularly, strokes caused by the bursting or blocking of a blood vessel in the brain.

In most parts of the world, 10% to 20% of adults have high blood pressure. Of course, not everybody

What a relief! "Blood pressure normal" is good news for your heart.

with the condition becomes seriously ill, but the higher the pressure and the longer it is elevated the more likely it is that disease will occur. Conse- quently, treatment aimed at reducing high blood pressure is very important

Measure more than once

The indirect measurement of arterial blood pressure is simple and painless.

An instrument called a sphygmo- manometer is used, and the procedure involves wrapping a cuff round the subject's arm and listening to sounds from an artery by means of a stetho- scope. Two values are obtained, the higher being called the systolic pressure and the lower the diastolic pressure and both are important However, cases occur quite often in which only the systolic or diastolic pressure is elevated, and they need special consideration.

Values up to 140 millimetres of mercury (mmHg) for systolic pressure and 90 mmHg for diastolic pressure are considered normal; values above 160 and 95 mmHg respectively are regarded as elevated. However, a diagnosis of high blood pressure should not rely on a single reading.

The average of at least two measure- ments made on three or more occa- sions, with the subject completely at rest, should be calculated before an individual is assessed as having high blood pressure (hypertension). This is very important because brief eleva- tions of blood pressure frequently occur.

Complications are lurking

The risk of complications is much greater with larger elevations of blood pressure. Just as a fast and careless driver is more likely to have a road

World Health • Jonumy·Februmy 1992

accident than a prudent one, a person with high blood pressure is more likely to suffer a stroke or heart attack than someone with normal blood pressure. Fortunately, however, by no means all individuals with high blood pressure develop such severe disease.

Some studies show that among men aged 50 whose systolic blood pressure is 180 mmHg or more, one in 100 can be expected to suffer a stroke within eight years. At first sight this may not seem remarkable, but among men of the same age who have normal blood pressure the corresponding rate is only one in 1000; in other words the relative risk for the individual with high blood pressure is ten times that of the normal individuaL Approximately seven in 100 men aged 50 with the same elevated blood pressure can be expected to have a heart attack within six years, whereas only three in I 00 men of this age with normal blood pressure are likely to do so.

Other risk factors

It should be noted that high blood pressure is not the only risk factor for heart attack. A smoker with high levels of blood fats and high blood pressure is seven times more likely to have a heart attack than a person without these risk factors. As for stroke, the risk is almost 15 times higher in the smoker with high blood fats and high blood pressure.

The message clearly is that an individual with all these risk factors should try to stop smoking, diminish fat consumption and lower his or her blood pressure. The latter can be achieved by weight control, modera- tion in the intake of salt and alcohol, and increased physical activity. If these measures are insufficient, drugs can be used to reduce the blood pressure; over 100 chemically different medicines are effective in this respect, and some of them are inexpensive.

Happily, the occurrence of complications of hypertension, namely stroke, heart attacks, and heart and renal failure, has been declining in a number of countries during recent decades. Some 20 years ago the health education slogan regarding high blood pressure was: "Beware of the silent killer!" ("silent" because high blood pressure itself is symptom less).

Today's message is: "Know your blood pressure-if it's high, have it treated". •

Or Thomas Strasser is Secretory-General of the World Hypertension League, 20 avenue du Bouchet, 1 209 Geneva, Switzrlond.

13

The Spanish health services ran a campaign to alert everyone to the value of checking their blood pressure.

Reducing the risk of a heart attack

The heart muscle is supplied with its blood through the two coronary arteries, which come off the main blood vessel of the body, called the aorta.

If one of these arteries becomes blocked the blood supply to a part of

the heart is cut off. This interferes with its normal action and causes pain (angina). The arteries may be blocked by one or more processes.

Furring up or atheroma may develop over many years until one of the arteries is more or less completely obstructed and angina or a heart attack results. Another possibility is that a blood clot or thrombus may form in one of the arteries and block it very suddenly, ohen in a position where it is already affected by atheroma. Obstruction can also be caused by a splitting of the arterial wall.

Can heart aHacks be prevented?

Our knowledge of the causes of heart attacks is still incomplete.

Consequently, complete protection cannot be guaranteed. However we know enough to be able to give practical advice on reducing the risk

that heart attacks will occur.

• smoking should be avoided.

•Dietary fat should be restricted, especially that obtained from animal sources.

•The blood pressure should be monitored and, if it is elevated, treatment should be given to lower it. Restriction of dietary salt is recommended for patients with high blood pressure.

•obesity should be avoided, especially in early and middle life.

•Regular physical exercise is desirable within the individual's capacity. Walking and swimming are two examples of appropriate activities.

•In women the use of oral contra·

ceptives should be reviewed from time to time. They present virtually no danger for healthy young women. There are grounds for considering other methods of contraception in women over 35 who smoke. Other methods are also to be preferred in women with certain medical conditions,

especially diabetes and high blood pressure, and in those with a family history of heart attack.

Adapted from Reducing the risk of a heart attack, a brochure published by British Heart Foundation, 14 Fitzhording Street, London W 1 H 4DH, England.

14

Uncle Scrooge and Donald's nephews are keen to stay healthy. But what about Donald Duck?

World Health • January-February 1992

© 015NEY

Children will enjoy colouring this drawing, made specially for World Health by Alessandro Perina, of the Wait Disney University, Milan, Italy.

World Health • January-February 1992 IS

Course to HEART HEALTH

a WHO game for the young at heart

Equipment: Board.

40 cards denoting risks to heart health.

The Rules:

1. Players throw dice to determine turns.

Highest starts the game.

2. a) First, the player throws dice to get on/to the heart board, thus beginning the way to

heart health,

which can be

enhanced or retarded by life-styles.

b) Then, continuing immediately, the player draws a card depicting life-styles-"Diet", "Tobacco",

"Exercise"- and reads out loudly and clearly the statement and the response to it.

3. With a card saying "Bravo!" the player advances the number of squares indicated towards the goal of

heart health.

Physical Activity and Sports (PAS) Guide

1.

_.

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2.

3.

Stand erect with feet apart, arms out -stretched

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horizontally, then flex knees _ to the left and to the right.

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ARMS

Stand at attention, with feet together and body upright, then circle arms from sides to over head.

WAIST

Stand erect with feet apart, hold arms bent across chest, then turn waist from left to right.

Guide to Healthy Living.

Physical Activity and Sports (PAS) Guide.

4. Or, with a "Boo!" card, the player retreats from heart health, as indicated. As a "Boo!" card denotes a risk to healthy living, it carries an additional penalty, requiring players to:

,,,. do an exercise from the Physical Activity and Sports (PAS) Guide;

,,,. read loudly and clearly a message from the Guide to Healthy Living.

5.

Then the next player begins.

6. If the WHO card defming health is drawn, the player advances

3

squares.

7. Players miss 2 turns when landing on the four

"Monster" squares, marked Hypertension, Cholesterol, Tobacco, Inactivity.

8. The first player to arrive at the last square is the winner, achieving the goal of

"Heart Health".

4.

BACK

Stand at attention, with arms held straight in front at shoulder height, then touch toes, if possible, without bending knees. Don't strain.

LEGS

From sitting position, leaning on arms extended behind back, raise and lower your legs slowly, without bending knees.

Do physical exercise regularly, and not only when you are playing

WHO's Course to Heart Health, to make you feel good all the time.

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Guide to Healthy living

and to the risks of heart diseases

(Read in a loud and clear voice I)

1 HIGH BLOOD CHOLESTEROL

Cholesterol is needed by my body; my liver produces it. However, if I eat too much fatty food, my blood choles- terol level can increase. High cholesterol is risky. It sticks to my artery walls, obstructs blood flow, and might cause a heart attack later in life.

2 HIGH BLOOD PRESSURE (OR HYPERTENSION)

Blood circulates through my arteries to bring oxygen and nourishment to my body. If the blood pressure becomes too high; and remains high over the years, that might cause a heart attack or stroke.

3 PASSIVE SMOKING

I'm a non-smoker; however when people around me smoke, I'm forced to breathe smoke-filled air. I then become a passive -or a non-smoking -smoker. Active smoking harms the health of the smoker. Passive smoking endangers my health. It also makes me smell, ugh!

4 SATURATED FAT

There are different kinds of fat: good and bad. Unsaturated fat, which is mainly liquid from plants, is good ..

Saturated fat, usually solid, is bad. Bad "sat fats" come mainly from animals, and dairy products, where the fat content has not been.reduced.

5 RISK FACTORS

There is the risk that I'll suffer from heart disease later in life- if I eat too much fatty or salty food, and become overweight; if I smoke; and if I watch too much television or play too many video games instead of taking physical exercise. Avoiding such risk factors, that's what this game is all about.

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Exercise

"/switched off the television and went out to play."

Bravo! Advance I square.

Physical activity and sport are better for your heart than just sitting still.

Exercise

"I can't afford all the gear you need for sports."

Boo! Go back 2 squares.

Walking, skipping, jogging, and swimming-some of the best ways to keep fit-cost little or nothing.

There's not much gear needed.

Keep fit! Do exercise No. 4 from the PAS Guide five times.

Exercise

"My mother prefers to cycle, rather than drive, to local shops, the library or the post office."

Bravo! Advance I square.

Cycling builds stamina, strengthens muscles, keeps weight down, and doesn't pollute the air.

Exercise

"My mother loves to swim. She takes the family with her whenever possible-including dad."

Bravo! Advance 2 squares.

Your whole body gets a workout in swimming: it's ideal as a sport and exercise.

Tobacco

"I embarrassed my doctor, who was puffing on a cigarette. I asked him if he thought smoking was bad

for us kids."

Bravo! Advance 3 squares.

It's the responsibility of all health people-particu- larly physicians-to practise what they preach and set

an example by not smoking.

Exercise

"/don't like team sports, so I skip instead."

Bravo! Advance 2 squares.

Skipping is easy to do. It's healthy, it's cheap, and all you need is a piece of rope.

Exercise

"My uncle, who is in his 40s, says he doesn't need to exercise as he was a top athlete in his teens."

Boo! Go back I square.

Fitness is not something you can save for the future.

Exercise should be done daily-like brushing your teeth. Keep fit! Do exercise No. 4 from the PAS Guide five times~ Also, read aloud from para. 5 of

the Guide to Healthy Living.

Exercise

"My dad, who is 50, says exercise won't make him live longer, so why bother?"

Boo! Go back 2 squares.

Exercise will improve the quality of his life a lot, and maybe he will even live longer. He will certainly be

active and independent much longer. Keep fit! Do exercise No. 2 from the PAS Guide ten times. Also,

read aloud from para. 5 of the Guide to Healthy. Living.

Exercise

"My grandparents have joined a gym class for senior citizens and they go dancing regularly.

How embarrassing!"

Boo! Go back 3 squares.

Not at all: they're young at heart! Exercise keeps them supple. You like dancing, why shouldn't they?

Keep their good example in mind when your time comes. Keep fit! Do exercise No. I from the PAS

Guide ten times.

Tobacco

"If I thought my smoking really annoyed my friends or damaged their health, I would quit."

Bravo! Advance 2 squares.

Tobacco smoke irritates the eyes and throat of non- smokers. Even worse, non-smokers-particularly

wives or husbands-have died from lung cancer because they were exposed to tobacco smoke.

So stop now!

Exercise

"I don't exercise. Why should J?"

Boo! Go back 3 squares.

Exercise strengthens your heart and lungs, lowers blood pressure, and toughens bones and muscles.

Keep fit! Do exercise No. I from the PAS Guide ten times. Also, read aloud from para. 5 of the Guide to

Healthy Living.

Exercise

"Our dog gets terribly excited when I say 'walk'.

So off we go!"

Bravo! Advance 2 squares.

Dogs are intelligent. Give yours a pat and take him for a walk-the longer the better for both of you.

Exercise

"My aunt and uncle have tough jobs, and look after three children. They say they are too tired, and have

no time for exercise."

Boo! Go back I square.

Suggest weekend hikes with the family-neither forced marches, nor strolls, but brisk walking. By exercising the legs, you exercise the heart, and relax the mind. Keep fit! Do exercise No. 3 from the PAS

Guide ten times.

Tobacco

"I asked a young woman to put out her cigarette. She was smoking in the non-smoking section of the

cafeteria."

Bravo! Advance 2 squares.

Smoking harms the health of others. Smokers and non-smokers favour non-smoking areas, especially in

eating places because smoking spoils the taste of food.

Tobacco

"A tobacco company offered to finance the inter- schoolfootba/1 championship match./ said 'no

thanks'."

Bravo! Advance 2 squares.

Most countries ban tobacco advertising on radio and television. To beat the ban, companies sponsor sports

and cultural events that attract the mass media.

This is "indirect advertising."

Exercise

"Me! I never, ever walk upstairs-or even downstairs for that matter!"

Boo! Go back 2 squares.

Stairs are good for you. And walking up or down them is so simple to do.

Keep fit! Do exercise No.5 from the PAS Guide five times.

Exercise

"My school is cutting down on its sports programme.

/'m organizing a students' protest."

Bravo! Advance 2 squares.

Children watch too much television. They need physical activity and sports to keep in shape.

Exercise

"My cousin says sports are unhealthy: many

professional athletes are often injured."

Boo! Go back I square.

The 'pros' push themselves to the limit to win. But for you it's not winning that counts, but taking part, which is the Olympic ideal. Keep fit! Do exercise

No. 5 five times from the PAS Guide.

Tobacco

"My mother was hooked as a kid. She says it's too

late for her to benefit from quitting.

I said it is never too late .. "

Bravo! Advance 3 squares.

You're right. It makes no difference how long she's been dependent. The risks of lung cancer or heart disease are reduced considerably no matter when a

smoker quits.

Tobacco

"Once when the non-smoking section on a plane was

full, my dad demanded that extra seats be made

available so that we could travel free from smoke."

Bravo! Advance 3 squares.

Most passengers don't know about the possibility of extending the non-smoking section.

It is recommended by the International Air Transport Association.

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Tobacco

"Yes, I know 31 May each year is observed as WHO's World No-Tobacco Day."

Bravo! Advance 1 square.

On this day, those who smoke or chew tobacco are asked to stop for at least 24 hours, as a first step to

breaking free.

Tobacco

"Passive smoking! What's that? Never heard of it."

Boo! Go back 3 squares.

Passive smoking is being obliged to breathe the smoke produced by someone else. Read aloud from

para. 3 of the Guide to Healthy Living.

Food

"My parents tell me to cut down on fat, soft drinks, snacks, but they don't do it themselves.

I told them that doesn't make sense."

Bravo! Advance 1 square.

Eating and living healthfully is always easier when parents set the example, and show you how.

Food

"WHO says there is one basic recipe for good health, and to avoid illness.

It applies to all people. I believe it!"

Bravo! Advance 3 squares.

Yes, rely on starches, vegetables, fruits; favour fish;

choose lean meat and low-fat dairy products; and keep sugar and salt down.

Food

"Saturated fat! Never heard of it. What's that?"

Boo! Go back 1 square.

Saturated fats are mainly from animal sources and damage the arteries. Read aloud from para. 4 of the

Guide to Healthy Living.

Tobacco

"Why shouldn't I smoke if I want to? It's my business. I'm not hurting anyone."

Boo! Go back 3 squares.

You're causing stress; you're worrying those who love you most. They know that lung cancer and heart

diseases are linked to tobacco. They're concerned about your health. Read aloud from para. 3 of the

Guide to Healthy Living.

Tobacco

"My aunt smokes filter-tipped cigarettes.

She says they are better for her health."

Boo! Go back I square.

A filter does not screen out carbon monoxide, which is the same gas that comes from the exhaust pipe of a car. Read aloud from para. 2 of the Guide to Healthy

Living.

Food

"!love starchy foods, like bread, cereals, potatoes, spaghetti, noodles, rice."

Bravo! Advance 2 squares.

These are staple foods for all peoples, a source of fibre, vitamin B, and minerals.

Eat up, they're healthy.

Food

"My mother always uses vegetable oil for cooking."

Bravo! Advance 2 squares.

That'll keep the family healthy. Give her a hug.

Food

"Cholesterol! My parents and their friends keep talking about it, but I've no idea what it means."

Boo! Go back I square.

Cholesterol is a natural substance produced by the body, but an excess-caused by too much fatty food-

can be dangerous. Read aloud from para. I of the Guide to Healthy Living.

Tobacco

"Sure, I smoke. It's sexy to smoke. It's exciting."

Boo! Go back 2 squares.

When your clothes, hair, and breath stink of tobacco smoke, it's repelling. Get rid of your dragon's breath.

Kiss a non-smoker, taste the difference!

Tobacco

"res, I smoke. It's my choice."

Boo! Go back 2 squares.

A choice means that you can say 'yes' or 'no'. A smoker who can't say 'no' is an addict, probably

hooked as a youngster who didn't know better.

Where's the choice?

Food

"/love seafood."

Bravo! Advance 2 squares.

Fish is low in fat, high in vitamins, rich in poly- unsaturated fat-the good fat. But don't overdo

smoked, pickled or salted fish.

Food

"Heart disease! That' sfor my parents or my grandparents, not for me."

Boo! Go back 3 squares.

Heart diseases begin when you're young.

Arteries already begin to clog by the age of 20. Read aloud from paras. I and 2 of the Guide to Healthy

Living.

Food

"Heart diseases are not a problem for us in the developing world.

They affect industrialized countries only."

Boo! Go back 2 squares.

Developing countries are becoming more affluent and suffering from life-style diseases, such as heart attacks and strokes. Read aloud from paras. 2 and 5

of the Guide to Healthy Living

Tobacco

"My uncle says he's got a right to smoke. I agree."

Boo! Go back 2 squares.

Two-thirds of any population are non-smokers.

Smoking is not a right; it is a privilege, which violates the right of non-smokers to breathe smoke-

free air. Read aloud from para. 3 of the Guide to Healthy Living.

Tobacco

"Who' re you kidding? Smoking is a habit, not an addiction!"

Boo! Go back I square.

The nicotine in a cigarette creates dependence.

Nicotine is as addictive as heroine and cocaine.

Although it's hard to stop, it can be done. Better not to start. Read aloud from para. 5 of the Guide to

Healthy Living.

Food

"/love poultry, mostly chicken and turkey."

Bravo! Advance I square.

They're almost fat-free after you trim off the skin.

If, after cooking, the meat is still raw near the bone, put it back in the oven until done all the way through.

Food

"/like junk food. What's wrong with a burger or chips?"

Boo! Go back 2 squares.

Frequently the meat drips with saturated fats-the bad fat-and the chips are fried in saturated oil.

Read aloud from para. 4 of the Guide to Healthy Living.

HEALTH is a state of COMPLETE physical, mental and social well-being and not merely the

ABSENCE of disease or infirmity.

(From the Preamble to the WHO Constitution)